Impact of the addition of carboplatin to anthracycline‐taxane‐based neoadjuvant chemotherapy on survival in BRCA1 /2 ‐mutated triple‐negative breast cancer

Whether adding carboplatin to standard neoadjuvant chemotherapy improves survival in BRCA1/2-mutated triple-negative breast cancer is unknown. In this retrospective study, we aimed to explore the efficacy of anthracycline-taxane- or anthracycline-taxane/carboplatin-based neoadjuvant chemotherapy in BRCA1/2-mutated triple-negative breast cancer. 1,585 operable primary breast cancer patients were treated with either neoadjuvant anthracycline followed by taxane (A-T) (n=886) or anthracycline followed by taxane plus carboplatin (A-TP) regimen (n=699). BRCA1 and BRCA2 germline mutations were determined in all subjects. Pathological complete response (pCR), recurrence-free survival (RFS), distant recurrence-free survival (DRFS), and overall survival (OS) were estimated. Of the entire cohort, 102 patients (6.4%) carried a pathogenic BRCA1/2 germline mutation. After a median follow-up of 81 months, no significant differences in survival between the A-T and A-TP arms were found in the entire cohort. However, among 288 triple-negative breast cancer patients, BRCA1/2 mutation carriers had significantly better survival when treated with the A-TP regimen than with the A-T regimen (5-year RFS: 82.6% vs 47.9%; P=0.024; 5-year DRFS: 88.5% vs 46.9%; P=0.010; 5-year OS: 88.2% vs 49.9%; P=0.036). Multivariate analyses revealed that the A-TP regimen was a significantly favourable factor for RFS and DRFS and showed a trend towards better OS when compared with the A-T regimen in BRCA1/2-mutated triple-negative breast cancer (RFS: adjusted hazard ratio [HR],0.24; 95% confidence interval [CI],0.06-0.91, P=0.035; DRFS: HR,0.17; 95% CI,0.03-0.80; P=0.025; OS: HR,0.29; 95% CI,0.06-1.49; P=0.14). Our study suggested that BRCA1/2-mutated triple-negative breast cancer patients gain a survival benefit when carboplatin is added to standard anthracycline-taxane-based neoadjuvant chemotherapy. This article is protected by copyright. All rights reserved.